Dysphonic Children: Performers vs. Non-Performers

This study sought to determine any differences in presenting complaints of dysphonia, diagnoses found, and the selected management in a group of 100 pediatric performers compared to a group of 100 pediatric non-performers.

Retrospective descriptive study with chart review of 200 children evaluated at a pediatric Voice Clinic for primary report of dysphonia.

Medical records of 200 children (100 consecutive performers, 100 consecutive non-performers) with a chief complaint of dysphonia were reviewed for history, diagnosis, and management.

Singers' performing levels included avocational, professional, solo performer, choral, musical theatre classical, and pop/commercial. The age range for singer patients was 8-20 years, while the age range for non-singer patients was 4 months to 21 years. Females dominated the singer group (27 males,73 females) while males dominated the non-singer group (58 males, 42 females). Organized sports involvement was similar for both groups. Voice disability (pediatric voice handicap index) was rated significantly higher for non-singers (non-singers 37.9, singers 21.5). The most common diagnoses for singers were reflux, allergic rhinitis, muscle tension dysphonia, and vocal fold mass. The most common diagnoses for non-singers were vocal fold mass, reflux, vocal fold paralysis, and tonsillar hypertrophy. Non-singers were referred for phono-surgery and tonsillectomy at a significantly higher incidence compared to the singer group. Referrals to gastroenterologist and referrals to allergist were similar between groups.

Laryngologists need to recognize the complexity of performance demands on the pediatric performer, as well as recognizing their concerns, as well as those of their support team, while still addressing common childhood diagnoses. Reflux laryngitis was a common diagnosis in both groups, but at a significantly higher incidence for singers. Vocal fold mass was a common diagnosis in both groups, but at a significantly higher incidence for non-singers.